PMT16-02256 Uily of Menifee Permit No.: PVC 16-02256
29714 HAUN RD.
�CCEL/� MENIFEE, CA 92586 Type: Residential Re-Roof
MENIFEE - Date Issued: 0711 412 01 6
FIE RMIT
Site Address: 28200 CHULA VISTA DR, MENIFEE, CA Parcel Plumber: 336-213-003
92586 Construction Cost: $4,000.00
Existing Use: Proposed Use:
Description of TEAR OFF EXISTING LAYERS, INSTALL NEW COOL ROOF SHINGLES
Work: "CRRC#0850-0015
Owner Contractor
RAY FILMORE R&R ROOFING
28200 CHULA VISTA DRIVE 26338 RIM CREEK PATH
MENIFEE,CA 92586 MENIFEE, CA 92584
Applicant Phone:9512460695
RAUL JASSO License Number:934782
R&R ROOFING
26338 RIM CREEK PATH
MENIFEE, CA 92584
Fee Description QN Amount i81
Building Permit Issuance
Inspections not specified 98 98.00
GREEN FEE
General Plan Maintenance Fee-Building 1 4.90
$130.90
The issuance of this permit shall not prevent the building official from thereafter requiring the correction of errors in the plans and
specifications or from preventing builiding operations being carried on thereunder when in violation of the Building Code or of any other
ordinance of City of Men'dee.Except as otherwise stated.a permit for construction under which no work is commenced within six
months after issuance,or where the work commenced is suspended or abandoned for six months,shall expire,and fees paid shall be
forfeited.
AA_Bldg_Permit_Template.rpl Page 1 of 1
CITY OF MENIFEE
LICENSED DECLARATION property who builds or improves thereon,and who contracts for the projects
with a licensed contractor(s)pursuant to the Contractors State License Law).
I hereby affirm under penalty of perjurythat I am under provisions of
Chapter9(commencing with section 7000)of Division 3 of the Business and ❑1 am exempt from licensure under the Contractor's State License Law for
Professions Code and POW
license is in full force and effect. the following reason:
License Class t'C_Zl^ G 3q License No. 613 41 By my signature below l acknowledge that,except for my personal residence
Expires ( J�Signature In which I must have resided for at least one year priorto completion of
improvements covered by this permit.I cannot legally sell a structure that I
WORKER'S COMPENSATION DECLARATION have built as an owner-builder if it has not been constructed in its entirety by
D I hereby affirm under penalty of perjury one of the following declarations:I licensed contractors.I understand that a copy of the applicable law,Section
have and will maintain a certificate of consent of self-insure forworkers 7044 of the Business and Professions Code,is available upon request when
compensation,issued by the Director of Industrial Relations as provided for this application is submitted or atthe following website:
hy5ection 3700 of the Labor Code,forthe performance of work forwhich www.leeinfo.ca.aov/calaw.htmL
this permit is issued.
Policy# SWI-G COMIP 4M ' tdJ Date
s�l have and will maintain workers compensation insurance,as required by PROPERTY OWNER OR AUTHORIZED AGENT
section 3700 of the Labor Code,for the performance of the work for which o By my signature below I certify to each of the following:I am the property
this permit is issued.My workers compensation insurance carrier and policy owner or authorized to act on the property owners behalf.I have read this
number are: application and the information I have provided is correct.I agree to comply
TF, WM� v^ S with all applicable city and county ordinances and state laws relating to
Carrier oq building construction.I authorize representatives of this city or county to
Policy# (O Expires X/i I y, enter the above identified property for inspection purposes.
(This section need not to be completed is the permit is for one-hundred Date
dollars($100)or less PROPERTY OWNER OR AUTHORIZED AGENT
D I certify that in the performance of the work for which this permit is issued,
I shall not employ any persons in any manner so as to become subject to the CITY BUSINESS LICENSE#
workers compensation laws of California,and agree that If I should become HAZARDOUS MATERIAL DECLARATION
subject to the workers compensation provisions of Section 3700 of the Labor
Code,I shall forthwith pmally with those provisions. ''++ Will the applicant or future building occupant handle hazardous material or
jT (�' mixture containing a hazardous material equal to or greater that the
Applicant Date 7
amounts sl{
WORKER'S COMPENSATION COVERAGF IS I ��cified on the Hazardous Materials Information Guide?
W WARNING:FA TO SECURE Yes dMa
UNLAWFUL,AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES Will the intended use of the building by the applicant or future building
AND CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS($100,000),IN occupant require a permit for the construction or modification from South
ADDITION TO THE COST OF COMPENSATION,DAMAGES AS PROVIDED FOR Coast Air Quality Management District(SCAQMD)?See permitting checklist
IN SECTION 3706 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES forguideli es
CONSTRUCTION LENDING AGENCY ❑Yes 2No
I hereby affirm that under the penalty of perjury there is a construction Will the proposed building or modified facility be within 1000 feet of the
lending agency for the performance of the work which this permit is issued outer boun ary of a school?
(Section 3097 Civil Code) ❑Yes o
OWNER BUILDER DECLARATIONS I have read the Hazardous Material Information Guide and the SCAQMD
permitting checklist.I understand my requirements under the State of
I hereby affirm under penalty of perjury that I am exempt from the California Health&Safety Code,Section 2S505 and 25534 concerning
Contractors License Law for the reason(s)indicated below by the hazardou�mat erial rep ing.
checkmark(s)I have placed next to the applicable item(s)(Section 7031.5 oYes o
Business and Professions Code).Any city or county that requires a permit to 1�
Date
construct,alter,improve,demolish or repair any structure,prior to its PROPERTY N OR AUTHORIZED AG ENT
issuance,also requires the applicant for the permit to file a signed statement
that he or she is licensed pursuant to the provisions of the Contractors State EPA RENOVATION.REPAIR AND PAINTING IRRP)
License Law(Chapter 9(commencing with Section 7000)of Division 3 of the The EPA Renovation,Repair and Painting(RRP)Rule requires contractors
Business and Professions Code)or that he or she is exempt from licensure receiving compensation for most work that disturbs paint in a pre-1978
and the basis for the alleged exemption.Any violation of Section 7031.5 by residence or childcare facility to be RRP-certified firms and comply with
an Applicant for a permit subjects the applicant to a civil penalty of not more required practices.This includes rental property owners and property
than($500). managers who do the paint-disturbing work themselves or through their
o I,as owner of the property,or my employee with wages as their sole employees.For more information about EPA's Renovation Program visit:
compensation,will do( )all of or( )portion of the work,and the structure is www.et)a.gov/lead or contact the National Lead Information Center at
not intended or offered for sale.(Section 7044,Business and Professions 1-800-424-LEAD(5323).
Code,The Contractors State License Law does not applyto an owner of a o An EPA Lead-Safe Certified Renovator will be responsible for this project
property who,through employees'or personal effort,builds or improves the
property provided that the improvements are not intended or offered for Certified Firm Name:
sale.If,however,the building or improvement is sold within one year of Firm Certification No:
completion,the Owner-Builder will have the burden of proving that it was
not built or improved for the purpose of sale. o No EPA Lead-Safe Certified Firm is required for this project because:
❑I,as owner of the property am exclusively contracting with licensed
contractors to construct the project(Section 7044,Business and Professions
Code:The Contractors State License Law does not apply to an owner of a If your project does not comply with EPA RRP rule please fill out the RRP
Acknowledgement.
-a ;Menifee
DATE 7 ly PERMIT/PLAN CHECK NUMBER
TYPE: O COMMERCIAL RESIDENTIAL O MULTI-FAMILY O MOBILE HOME O POOL/SPA C SIGN
SUBTYPE: O ADDITION C ALTERATIO/N O DEMOLITION O ELECTRICAL O MECHANICAL
O NEW C PLUMBING 13 RE-ROOF-NUMBER OF SQUARES IS
DESCRIPTION OF WORK — CAI' Ow L XIS,
PROJECTADDRESS 26Coo CwA \)&TA tt2 SUN 011 " GL5
ASSESSOR'S PARCEL NUMBER 35LO • I CO-j LOT TRACT
OWNER NAME
8o en ee
ing
ADDRESS Build , Safety Dept.
PHONE TS1 9zl c EMAIL
APPLICANT NAME
ADDRESS eceive
PHONE EMAIL
CONTRACTOR'S NAME : Z QazA OWNER BUILDER? C YES VNO
BUSINESS NAME
ADDRESS `RAYti1 Cdev, ` CAF,
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PHONE V I S] ZyU p�qS EMAIL 6 )N's F VY�C1 C. • oei
CONTRACTOR'S STATE LIC NUMBER - I>?q l b L LICENSE CLASSIFICATION G > I
VALUATION$ 0�= y 1C SO FT L SQ FT
APPLICANT'S SIGNATURE DATE
CITYSTAFFUSEONLY
DEPARTMENT DISTRIBUTION CITY OF MENIFEE BUSINESS LICENSE NUMBER
BUILDING PLANNING ENGINEERING FIRE GREEN SMIP X
INVOICE I .W /y PAIDAMOUNT �/� �/� (,
AMOUNT 7G/AO 1.,. ,-C• (f CASH UCHECK# UCREDI7 CARD VISA/MC
PLAN CHECK FEES PAID AMOUNT O CASH O CHECK# U CREDIT CARD VISA/MC
OWNER BUILDER VERIFIED O YES 0 NO DL NUMBER NOTARIZED LETTER O YES O NO
City of Menifee Building a Safety Department 29714 Houn Rd. Allenifee, CA 92586 951-672-5777
www.cityofinenifee.us Inspection Request Line 951-240'-6213
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